| NPI | 1154592111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA py00003885) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA PSY10001800) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2026-06-12 |